Archive for category TBI

A TBI can happen to anyone, whether it happens while playing sports, at work, or just slipping on an icy sidewalk. Injuries can range from “mild” to “severe”, with a majority of cases being concussions or mild TBI. The good news is that most cases are treatable and there are several ways to help prevent injury.

Abstract

Brain injury represents a major public health issue in the United States, accounting for a largely underestimated figure of 2.5 million cases in 2010. The pervasive effects of this chronic medical condition contribute to a growing economic burden, as the physical, cognitive, behavioral, and emotional sequelae of brain injury demand long-term care for those with moderate-to-severe brain injuries. The Centers for Disease Control and Prevention recently proposed new recommendations for improvements in monitoring the incidence of and research on brain injury. The goals of this public health initiative are to better inform health service delivery and ultimately improve quality of life for those affected, as well as their loved ones.
In addition to improved quality of life, community reintegration is a primary goal
of brain injury rehabilitation. Engagement in rehabilitation is largely dependent upon an individual’s level of impairment, as well as other personal factors. For example, research examining the relationship between targeted interventions and community participation has established support for the protective effects of self-efficacy, or personal belief in one’s abilities to achieve a desired goal. Additional research on the importance of selfefficacy to psychological health has provided further support for the protective effects of this construct against depression and anxiety. Therefore, further research into the relationship between rehabilitation outcomes, psychological health, and self-efficacy is necessary to inform recommendations for improving health service delivery and quality of life for this vulnerable population.

The aim of the present study is to examine factors that may be related to self
efficacy in persons with moderate-to-severe brain injury who receive treatment at along term post acute brain injury program. The implications of this research include baseline assessment of self-efficacy in this sample that could potentially inform future staff training and overall clinical practice geared towards cultivating self-efficacy in persons with brain injury. The primary limitations of this study are its small sample size and constrained external validity. Despite these limitations, more research is necessary to understand the role of psychological protective factors in brain injury rehabilitation and to inform strategies for improved health service delivery and increased quality of life.

Abstract

Background

Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.

Objective

In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time.

Methods

Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included.

Results

In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus.

Conclusions

The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.

RESULTS: Most frequently administered were narcotic analgesics (72% of sample),
followed by antidepressants (67%), anticonvulsants (47%), anxiolytics (33%),
hypnotics (30%), stimulants (28%), antipsychotics (25%), antiparkinson agents
(25%), and miscellaneous psychotropics (18%). The psychotropic agents studied
were administered to 95% of the sample, with 8.5% receiving only 1 and 31.8%
receiving ≥6. Degree of psychotropic medication administration varied widely
between sites. Univariate analyses indicated younger patients were more likely to
receive anxiolytics, antidepressants, antiparkinson agents, stimulants,
antipsychotics, and narcotic analgesics, whereas those older were more likely to
receive anticonvulsants and miscellaneous psychotropics. Men were more likely to
receive antipsychotics. All medication classes were less likely administered to
Asians and more likely administered to those with more severe functional
impairment. Use of anticonvulsants was associated with having seizures at some
point during acute care or rehabilitation stays. Narcotic analgesics were more
likely for those with history of drug abuse, history of anxiety and depression
(premorbid or during acute care), and severe pain during rehabilitation.
Psychotropic medication administration increased rather than decreased during the
course of inpatient rehabilitation in each of the medication categories except
for narcotics. This observation was also true for medication administration
within admission functional levels (defined by cognitive FIM scores), except for
those with higher admission FIM cognitive scores.

CONCLUSIONS: Many psychotropic medications are used during inpatient
rehabilitation. In general, lower admission FIM cognitive score groups were
administered more of the medications under investigation compared with those with
higher cognitive function at admission. Considerable site variation existed
regarding medications administered. The current investigation provides baseline
data for future studies of effectiveness.